Love Hurts

"That will be us someday!" It's the sweet wish of a young couples when they spy older couples on the street, in restaurants, on the dance floor who still seem to be in love. 

But the other side of that wish is this: love may have no expiration date, but all people do. Death of a partner is most likely to happen in old age, more likely to happen to older women, and is often considered to be one of the most traumatic events a person can experience.

This sort of loss, or bereavement, is often related to Major Depressive Disorder (clinical depression). The most recent version of the Diagnostic and Statistical Manual (DSM-V) removed the "bereavement exclusion": thus a grieving person who exhibits the symptoms of depression may receive that diagnosis even though these symptoms are a normative response to loss of a loved one.

Fried, Bockting, Arjadi, Borsboom, Amshoff, Cramer, Epskamp, Tuerlinckx, Carr, and Streoebe (2015) note that we often assume bereavement causes a person to have depression, and depression produces symptoms. This is called the "Common Cause Hypothesis" because all symptoms are thought to come from one situation: depression. However, the authors caution us that this hypothesis may not be appropriate because there are thousands of symptoms that depressed people may have, these may contradict each other (e.g.; some depressed people eat too much while other depressed people don't feel like eating at all), and risk factors, such as suicide, may vary depending on the constellation of symptoms that an individual exhibits.

Instead, Fried et al. (2015) encourage us to consider a Network model. From this view, bereavement would cause symptoms, and these symptoms would create situations, such as depression. These symptoms could also interact with (influence) each other to produce such situations.

To test these two viewpoints, the authors used data on depression symptoms from the Changing Lives of Older Couples (CLOC) study. First, they compared the scores on a depression test from 241 widowed seniors (from Follow-Up 1) to 274, age- and gender-matched, married seniors (from Follow-Ups 1-3). The majority of the participants were female and senior citizens. When these individuals joined the CLOC study there was no difference in their reported depression symptoms, but in the follow-up interviews, six months after the death of a spouse the bereaved seniors demonstrated slightly more of these symptoms compared to the seniors who were still married. In fact, 84 of the widowed seniors exceeded the criteria for Major Depressive Disorder by endorsing at least six symptoms. The most commons symptoms were: feeling lonely; feeling sad; feeling depressed; having trouble motivating themselves; problems sleeping; problems eating.

Then Fried et al. (2015) applied complicated statistical models to see if the Common Cause or the Network frameworks would best explain the relationship between bereavement, depression, and depression symptoms. For the Common Cause model to be supported these six symptoms should be better predicted by Depression; instead four of these symptoms were better predicted by loss itself (bereavement) lending support to the Network model. Further investigation revealed that bereavement was especially linked to one symptom, feeling lonely.

These results caution us to think more broadly about depression and spousal loss in older age, especially for older women. Instead of assuming that bereavement causes depression, it may be that bereavement causes a set of symptoms including loneliness. In turn, it could be that this loneliness is what eventually leads a person to experience Major Depressive Disorder. 

As this week's meme suggests, true love may last forever: into old age and even when the person we love is gone. With love still in our hearts but now suddenly on our own, it is easy to see how loneliness could set in. And that is a depressing thought.

FURTHER READING:

The Fried et al. (2015) Journal of Abnormal Psychology article can be accessed through your local college library.

Advice from the American Association of Retired Persons (AARP) on ways to survive bereavement.

WebMD's suggestions to "Help Yourself Out of Depression." If loneliness or depression are causing you to have suicidal thoughts, it is very important that you get help. In the U.S. you can call the National Suicide Prevention Lifeline is 1-800-273-8255.

BONUS!

A TEDx talk by Dr. John Cacioppo on "The Lethality of Loneliness."

Driving While Old

My husband and I have made a pact:  when we are Senior Citizens we will remind each other that we probably do not drive as well as we think we do.  As noted in this meme, it is not uncommon for older Seniors to make certain driving errors, such as driving too slowly:

According to the National Institutes of Health, other common driving errors in later life are, "failing to yield the right of way, failing to stay in your lane, misjudging the time or distance needed to turn in front of traffic, failing to stop completely at a stop sign, and speeding...."  Surprisingly, there are not many studies in psychology that link specific age-related changes in thinking (cognition) to specific driving errors.

One such study was done in Australia by Anstey and Wood (2011) who recruited 266 volunteers between the ages of 70-88 who reported that they drove at least once a week on a regular basis.  These Seniors took a battery of cognitive tests and also went for a 50 minute drive supervised by an instructor, and accompanied by an occupational therapist who noted any driving errors that occurred.

Some of their results replicated past research.  For example, all driving errors quadrupled with increasing age of participant - so my husband and I will have less to worry about when we are in our 70s compared to our 80s.  Also, there were no gender effects - so we will not be able to predict if my husband or I will be the safer driver; although women tend to outlive men so I am more likely to make it well into my 80s and thus up my risk of driving errors!

The factor that predicted the majority of the errors was called "Speeded Attention and Switching" and was made up of results from various tests of two specific cognitive processes that slow with aging:  speed of processing and task switching ability.  Speed of processing is how quickly you are able to recognize and understand how to react to new information that is coming your way.  Task switching ability is how well you are able to quickly and accurately switch your attention between two activities.  Because driving causes us all to encounter new information quickly (a dog runs into the street, the car ahead of us suddenly brakes, a cloudburst makes the pavement slick) and provides us many competing tasks (staying in our lane, obeying the speed limit, looking for road signs and stoplights) it is sensible that declines in these skills would correlate with driving errors.

One of these errors, "brake/accelerator problems" - which include driving too quickly or too slowly - returns us to our meme.  The Senior Romeo may be driving too slowly if it takes him longer to know where to focus his attention and longer for him to switch where his attention lies...especially if he is highly motivated to pay attention to his hot date!  By slowing down he may buy himself some time to compensate for these cognitive declines, which may give him the impression that he is still driving safely.

So if you have older relatives (or dates!) you may have some concerns about their driving.  This is especially likely if they are over age 80: "People 80 and older are involved in 5.5 times as many fatal crashes per mile driven as middle-­aged drivers."  However, more concern should be given to the teens in your life: "the crash rate for driver ages 16and 17...is almost nine times as high as that for middle-aged driver."  If you are middle aged you probably make few driving errors, but be careful - you are likely to be distracted as you worry about your Senior parents' and your adolescent children's driving.

Further Reading:

The Anstey and Wood (2011) journal article can be accessed through your local college library.

Test your own Speed of Processing!  The results will report your accuracy and speed at solving these novel problems.

How to talk to a Senior about safe driving. The NIH has some excellent ideas to get the conversation started.

The American Association of Retired Persons (AARP) has an official online dating site for Seniors.  You can talk about today's blog on your first date!